Monkeypox is a nightmare. And there could be a far worse scenario ahead.

Just imagine a President Ron DeSantis. And then imagine monkeypox -- or a more lethal pathogen -- spreading through LGBTQ communities.

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Monkeypox has become a major health threat, overwhelmingly affecting gay and bisexual men. According the the World Health Organization, more than 98% of cases are among men who have sex with men. Though it hasn’t yet happened, there’s been an expectation among many public health officials worldwide that the virus could begin to transmit beyond the queer community, among many other populations.

Other experts, as well some LGBTQ health advocates and some science journalists, believe the data on transmission so far shows that that is actually less likely to happen, and that we should be focused right now on the group most affected. (More on that further down.)

As I wrote several weeks ago, the response by the federal government as well as governments at every level, has been abysmal, from the rollout of vaccines to getting patients treatment for an illness that can cause excruciating pain.

Please take note that this shoddy federal response is coming during a presidential administration that is perhaps the most pro-LGBTQ in history, in words and deeds. President Biden has been a forceful advocate for marriage equality and transgender rights. He made history when he appointed a transgender woman as Assistant Secretary for Health, Admiral Rachel Levine, who was formerly Pennsylvania’s Secretary of Public Health. She’s the highest-ranking openly transgender person to serve in any presidential administration

Biden also made history when he appointed Karine Jean-Pierre, a lesbian woman, as White House Press Secretary, the president’s chief spokesperson. And Biden’s Secretary of Transportation, Pete Buttigieg, is another historic first as an openly gay Cabinet member.

Many of the responses to monkeypox by city and state officials that have also been lackluster are also led by pro-LGBTQ politicians, from New York to California (two of the states with the highest numbers of monkeypox cases).

The lack of preparedness by federal and state officials is coming after the catastrophic response to COVID-19 by the Trump administration and Republican governors, and with the heightened concern by many global public health officials that monkeypox will eventually break into the rest of the population.

So, it’s safe to say that the bungled response to monkeypox isn’t due to overt homophobia or a bowing to Christian nationalists in the way Ronald Reagan did with regard to HIV. Rather, government bureaucracy, particularly with regard to public health is, sadly, a major impediment in the United States today, and swift action on anything appears to be a painstaking task.

What is different, however, under a presidential administration that does care about healthcare outcomes is this: Making a lot of noise pushes officials to act. And we are now seeing that happen. The Biden administration declared monkeypox a public health emergency (even though the declaration came late) as LGBTQ health activists sounded the alarm, and the White House announced a team to lead the battle against monkeypox. Vaccines are getting to localities with more speed than at the beginning of the outbreak, though we’re still way behind the curve in the battle to stop monkeypox from becoming endemic.

So, now I’d like you to imagine scenarios that could become true in the not-too-distant future.

A new distillation of the available data by University of Southern California public health expert Dr. Jeffrey Klausner suggests that anal and oral sex, rather than skin-to-skin contact, may be the primary mode of transmission of monkeypox in the current outbreak. And that could be why monkeypox is transmitting primarily among men who have sex with men (most often in multiple partner situations) and is not turning up in populations of people who would contract it within households, at public facilities or as caregivers — not in any significant way.

As Ben Ryan reports at NBCNews.com:

A persistent misconception is that cases among women and children are going undiagnosed because they aren’t being tested.

While there have been a small number of pediatric cases, there's no evidence of sustained transmission, according to numerous national and regional health agencies.

Dawn O’Connell, the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, said on a call with reporters in July that monkeypox testing was being conducted outside of gay and bisexual men, “and we’re not seeing many positives.”

That is not to say that monkeypox can’t be transmitted via skin-to-skin contact or in other ways and among any group of people. It’s simply that monkeybox, according to Klausner, is similar to some other pathogens that transmit primarily via sexual activity even as they can and do transmit via other avenues:

Human monkeypox is not exclusively transmitted through sexual contact [2]. A related poxvirus, molluscum contagiosum, has similar transmission characteristics, which can be transmitted via both skin-to-skin contact and/or sexual contact [24]. Human herpes simplex viruses similarly can be transmitted via close skin-to-skin contact as well as through contact with bodily fluids during sex [25]. Similarly, Treponema pallidum pallidum, the cause of syphilis, is predominantly transmitted through sexual contact [26], yet historical reports prior to the routine use of protective gloves among medical professionals frequently noted syphilitic lesions on the fingers of physicians acquired via non-sexual skin-to-skin contact [27,28], as well as via human bites [29].

If that holds true — something we may learn in coming months and years — monkeypox will be defined as a virus, like HIV, that poses a very high risk to a particular community or communities but is viewed as very low risk in what media calls “the general population” (a term I hate because it translates to “people who matter.”)

Then imagine that Governor Ron DeSantis of Florida, who passed the horrendous “Don’t Say Gay” law and pushes the ugly “groomer” lie about gay men while portraying drag queens as dangerous to children, is elected president of the United States in 2024.

He is, after all, galvanizing the GOP base and hoping to take advantage of Trump’s downfall. And, per the polls of that base, he’s been competitive with Trump, even edging ahead in some state polls. (We could, of course, imagine the same scenario should Trump — or any Republican — win the presidency in 2024 as well.)

DeSantis has refused to declare a health emergency in Florida for monkeypox, though the state has the third highest number of cases (after New York and California, where governors have declared it a health emergency):

“Any of these politicians out there who are trying to scare you about this, do not listen to their nonsense,” DeSantis said. “I am so sick of politicians, and you saw this with COVID, trying to sow fear into the population.”..

…“You see some of these states declaring states of emergency. They’re going to abuse those emergency powers to restrict your freedom — I guarantee you, that’s what will happen. We saw it so much with COVID,” he said.

Florida is in dire need of vaccines and treatment, as is the case everywhere, and a public health emergency declaration would help speed resources. But a stew of grievance and conspiracy-mongering is DeSantis’s response, and it’s at a time when monkeypox is seen by public health officials as a threat to the entire population. As with COVID-19, DeSantis couches the public health concern as unwarranted, and floats the conspiracy theory that it’s due to government trying to take away “freedom.”

#TuckFrump @realTuckFrumper

‘We Are Not Doing Fear’: Ron DeSantis Blasts States Declaring Emergency Over Monkeypox

dlvr.it‘We Are Not Doing Fear’: Ron DeSantis Blasts States Declaring Emergency Over Monkeypox“I’m so sick of politicians — and we saw this with COVID — trying to sow fear into the population,” the Florida Republican said.

If it becomes clearer that monkeypox isn’t affecting people outside the LGBTQ communities in a big way but is spreading rapidly within those communities, DeSantis will make a complete u-turn: Hypocrisy be damned, he will go from defending “freedom” to attacking the freedoms of LGBTQ people, running on the issue in his presidential race.

You can imagine DeSantis demonizing gay men as vectors of disease just as he demonizes them now as “groomers” in the push of the “Don’t say gay” law and as he viciously attacks transgender people via laws he’s passed and verbal assaults. He may or may not do it subtly — or, as he’s done in the past with the “groomer” smear, he may leave it to his press spokesperson or others — but it will happen.

If you think the federal government has made a mess of the response to monkeypox now, imagine the willful negligence of a President DeSantis, bowing to the Christian nationalists in the MAGA base.

And then imagine something even more frightening but a real possibility: that a more lethal virus, for which there is no vaccine, begins circulating within gay sexual networks — as happened with regard to HIV decades ago.

Monkeypox can be excruciatingly painful and debilitating, but there have thankfully been no reported deaths in the United States. After a few weeks, symptoms clear and the patient fully recovers. And we do have a vaccine to prevent it.

The virus has been known about for many decades, and is endemic in Africa, mostly transmitted from animals to humans. This is the first time an outbreak outside of Africa has spread so widely — around the world — from person to person. Sex between men has been a driver of the outbreak. The virus found its way onto a sort of gay sexual superhighway.

There are surely many other viruses out in the world, some that are well-known, and others which we don’t know even exist. What if one of them makes it into gay sexual networks, and remains largely within those communities? What if it’s lethal and there is no vaccine or treatment? Surely, with everything we’ve seen in recent years, it’s not out of the realm of possibility.

In a time of rampant homophobia similar to what we saw promoted by Reagan’s ascendant Christian right army in the 1980s — with LGBTQ people portrayed as detrimental to society — it’s not difficult to fathom how a President DeSantis, or any Trumpist president, would respond. This is yet another potent example — as if we needed more — of the dangerous times we’re in, and why beating back the GOP is so vital.